Single part bandage and method for a medical sensor

ABSTRACT

A patient monitoring sensor having a communication interface, through which the patient monitoring sensor can communicate with a monitor is provided. The patient monitoring sensor includes a light-emitting diode (LED) communicatively coupled to the communication interface and a detector, communicatively coupled to the communication interface, capable of detecting light. The patient monitoring sensor includes a bandage that is constructed as a single piece such that plural layers of the bandage are configured together to allow for a leaflet opening of the bandage, for example using at least one removable liner or tab, to insert a pulse oximetry circuit therein.

FIELD

The present disclosure relates generally to medical devices, and moreparticularly, to medical devices that monitor physiological parametersof a patient, such as pulse oximeters.

BACKGROUND

In the field of medicine, doctors often desire to monitor certainphysiological characteristics of their patients. Accordingly, a widevariety of devices have been developed for monitoring many suchphysiological characteristics. Such devices provide doctors and otherhealthcare personnel with the information they need to provide the bestpossible healthcare for their patients. As a result, such monitoringdevices have become an indispensable part of modern medicine.

One technique for monitoring certain physiological characteristics of apatient uses attenuation of light to determine physiologicalcharacteristics of a patient. This is used in pulse oximetry, and thedevices built based upon pulse oximetry techniques. Light attenuation isalso used for regional or cerebral oximetry. Oximetry may be used tomeasure various blood characteristics, such as the oxygen saturation ofhemoglobin in blood or tissue, the volume of individual blood pulsationssupplying the tissue, and/or the rate of blood pulsations correspondingto each heartbeat of a patient. The signals can lead to furtherphysiological measurements, such as respiration rate, glucose levels orblood pressure.

One issue in such sensors relates to manufacturing of such sensors,including with regard to ease of manufacture, reliability of themanufactured sensor, repeatability of manufacture for large numbers ofmanufactured sensors, as well as ease, reliability, repeatability, etc.for the re-manufacture of sensors.

Traditional pulse oximeters, for example, are fairly complex with regardto the required usage of multiple parts having multiple liners, foldingoperations, etc., during manufacture of the sensor. Specifically,traditional assembly requires that a person manually align multiplelayers together, press the layers together (attempting to correctlymaintain alignment, avoid bubbles and avoid missing portions). Suchsensors can be costly to assemble and may suffer fromreliability/repeatability of the build. Less reliable performance mayresult, for example when layers are not laminated together properly,causing the layers to delaminate (open up) or when layers are notprecisely aligned together, for example if the holes for optics to passlight through are not centered well enough on the optics or othermaterials are out of place, causing pressure points on the patient.

What is needed in the art is a construction of a sensor that easesmanufacture and/or remanufacture of the sensor, while increasingreliability and repeatability of such manufacture or remanufacture.

SUMMARY

The techniques of this disclosure generally relate to medical devicesthat monitor physiological parameters of a patient, such as pulseoximeters.

In one aspect, the present disclosure provides a patient monitoringsensor having a communication interface, through which the patientmonitoring sensor can communicate with a monitor. The patient monitoringsensor also includes a light-emitting source, for example alight-emitting diode (LED), communicatively coupled to the communicationinterface and a detector, communicatively coupled to the communicationinterface, capable of detecting light. In exemplary embodiments, abandage is constructed as a single piece such that plural layers of thebandage are configured together to allow for a leaflet opening of thebandage to insert a pulse oximetry circuit therein. In exemplaryembodiments, at least one removable internal liner or tab is included aspart of the bandage to facilitate opening of the bandage via theleaflet.

In another aspect, the disclosure provides a patient monitoring system,having a patient monitor coupled to a patient monitoring sensor. Thepatient monitoring sensor includes a communication interface, throughwhich the patient monitoring sensor can communicate with the patientmonitor. The patient monitoring sensor also includes a light-emittingdiode (LED) communicatively coupled to the communication interface and adetector, communicatively coupled to the communication interface,capable of detecting light. The patient monitoring sensor furtherincludes a bandage is constructed as a single piece such that plurallayers of the bandage are configured together to allow for a leafletopening of the bandage to insert a pulse oximetry circuit therein. Inexemplary embodiments, at least one removable internal liner or tab isincluded as part of the bandage to facilitate opening of the bandage viathe leaflet.

The details of one or more aspects of the disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 illustrates a perspective view of an exemplary patient monitoringsystem including a patient monitor and a patient monitoring sensor, inaccordance with an embodiment;

FIG. 2 illustrates a perspective view of an exemplary patient monitoringsensor, in accordance with an embodiment;

FIG. 3 illustrates a schematic view of an exemplary patient monitoringsensor, in accordance with an embodiment;

FIG. 4 illustrates a layered schematic view of an exemplary patientmonitoring sensor bandage, in accordance with an embodiment;

FIG. 5 illustrates a perspective view of an exemplary sensor assembly;

FIG. 6 illustrates a blown-up, perspective view of another exemplarybandage; and

FIG. 7 illustrates an exploded, side schematic view of the exemplarybandage of FIG. 6.

DETAILED DESCRIPTION

Traditional pulse oximeters, for example, are fairly complex with regardto the required usage of multiple parts having multiple liners, foldingoperations, etc., during manufacture of the sensor. Such sensors can becostly to assemble and may suffer from reliability/repeatability of thebuild.

Accordingly, the present disclosure describes a bandage that isconstructed as a single piece such that plural layers of the bandage areconfigured together to allow for a leaflet opening of the bandage toinsert a pulse oximetry circuit therein. In exemplary embodiments, theleaflet is converted by a machine to cut the proper shapes, align theshapes together and laminate all layers together. In further exemplaryembodiments, at least one removable internal liner or tab is included aspart of the bandage to facilitate opening of the bandage via theleaflet.

Referring now to FIG. 1, an embodiment of a patient monitoring system 10that includes a patient monitor 12 and a sensor 14, such as a pulseoximetry sensor, to monitor physiological parameters of a patient isshown. By way of example, the sensor 14 may be a NELLCOR™, or INVOS™sensor available from Medtronic (Boulder, Colo.), or another type ofoximetry sensor. Although the depicted embodiments relate to sensors foruse on a patient's fingertip, toe, or earlobe, it should be understoodthat, in certain embodiments, the features of the sensor 14 as providedherein may be incorporated into sensors for use on other tissuelocations, such as the forehead and/or temple, the heel, stomach, chest,back, or any other appropriate measurement site.

In the embodiment of FIG. 1, the sensor 14 is a pulse oximetry sensorthat includes one or more emitters 16 and one or more detectors 18. Forpulse oximetry applications, the emitter 16 transmits at least twowavelengths of light (e.g., red and/or infrared (IR)) into a tissue ofthe patient. For other applications, the emitter 16 may transmit 3, 4,or 5 or more wavelengths of light into the tissue of a patient. Thedetector 18 is a photodetector selected to receive light in the range ofwavelengths emitted from the emitter 16, after the light has passedthrough the tissue. Additionally, the emitter 16 and the detector 18 mayoperate in various modes (e.g., reflectance or transmission). In certainembodiments, the sensor 14 includes sensing components in addition to,or instead of, the emitter 16 and the detector 18. For example, in oneembodiment, the sensor 14 may include one or more actively poweredelectrodes (e.g., four electrodes) to obtain an electroencephalographysignal.

The sensor 14 also includes a sensor body 46 to house or carry thecomponents of the sensor 14. The body 46 includes a backing, or liner,provided around the emitter 16 and the detector 18, as well as anadhesive layer (not shown) on the patient side. The sensor 14 may bereusable (such as a durable plastic clip sensor), disposable (such as anadhesive sensor including a bandage/liner at least partially made fromhydrophobic materials), or partially reusable and partially disposable.

In the embodiment shown, the sensor 14 is communicatively coupled to thepatient monitor 12. In certain embodiments, the sensor 14 may include awireless module configured to establish a wireless communication 15 withthe patient monitor 12 using any suitable wireless standard. Forexample, the sensor 14 may include a transceiver that enables wirelesssignals to be transmitted to and received from an external device (e.g.,the patient monitor 12, a charging device, etc.). The transceiver mayestablish wireless communication 15 with a transceiver of the patientmonitor 12 using any suitable protocol. For example, the transceiver maybe configured to transmit signals using one or more of the ZigBeestandard, 802.15.4x standards WirelessHART standard, Bluetooth standard,IEEE 802.11x standards, or MiWi standard. Additionally, the transceivermay transmit a raw digitized detector signal, a processed digitizeddetector signal, and/or a calculated physiological parameter, as well asany data that may be stored in the sensor, such as data relating towavelengths of the emitters 16, or data relating to input specificationfor the emitters 16, as discussed below. Additionally, or alternatively,the emitters 16 and detectors 18 of the sensor 14 may be coupled to thepatient monitor 12 via a cable 24 through a plug 26 (e.g., a connectorhaving one or more conductors) coupled to a sensor port 29 of themonitor. In certain embodiments, the sensor 14 is configured to operatein both a wireless mode and a wired mode. Accordingly, in certainembodiments, the cable 24 is removably attached to the sensor 14 suchthat the sensor 14 can be detached from the cable to increase thepatient's range of motion while wearing the sensor 14.

The patient monitor 12 is configured to calculate physiologicalparameters of the patient relating to the physiological signal receivedfrom the sensor 14. For example, the patient monitor 12 may include aprocessor configured to calculate the patient's arterial blood oxygensaturation, tissue oxygen saturation, pulse rate, respiration rate,blood pressure, blood pressure characteristic measure, autoregulationstatus, brain activity, and/or any other suitable physiologicalcharacteristics. Additionally, the patient monitor 12 may include amonitor display 30 configured to display information regarding thephysiological parameters, information about the system (e.g.,instructions for disinfecting and/or charging the sensor 14), and/oralarm indications. The patient monitor 12 may include various inputcomponents 32, such as knobs, switches, keys and keypads, buttons, etc.,to provide for operation and configuration of the patient monitor 12.The patient monitor 12 may also display information related to alarms,monitor settings, and/or signal quality via one or more indicator lightsand/or one or more speakers or audible indicators. The patient monitor12 may also include an upgrade slot 28, in which additional modules canbe inserted so that the patient monitor 12 can measure and displayadditional physiological parameters.

Because the sensor 14 may be configured to operate in a wireless modeand, in certain embodiments, may not receive power from the patientmonitor 12 while operating in the wireless mode, the sensor 14 mayinclude a battery to provide power to the components of the sensor 14(e.g., the emitter 16 and the detector 18). In certain embodiments, thebattery may be a rechargeable battery such as, for example, a lithiumion, lithium polymer, nickel-metal hydride, or nickel-cadmium battery.However, any suitable power source may be utilized, such as, one or morecapacitors and/or an energy harvesting power supply (e.g., a motiongenerated energy harvesting device, thermoelectric generated energyharvesting device, or similar devices).

As noted above, in an embodiment, the patient monitor 12 is a pulseoximetry monitor and the sensor 14 is a pulse oximetry sensor. Thesensor 14 may be placed at a site on a patient with pulsatile arterialflow, typically a fingertip, toe, forehead or earlobe, or in the case ofa neonate, across a foot. Additional suitable sensor locations include,without limitation, the neck to monitor carotid artery pulsatile flow,the wrist to monitor radial artery pulsatile flow, the inside of apatient's thigh to monitor femoral artery pulsatile flow, the ankle tomonitor tibial artery pulsatile flow, and around or in front of the ear.The patient monitoring system 10 may include sensors 14 at multiplelocations. The emitter 16 emits light which passes through the bloodperfused tissue, and the detector 18 photoelectrically senses the amountof light reflected or transmitted by the tissue. The patient monitoringsystem 10 measures the intensity of light that is received at thedetector 18 as a function of time.

A signal representing light intensity versus time or a mathematicalmanipulation of this signal (e.g., a scaled version thereof, a log takenthereof, a scaled version of a log taken thereof, etc.) may be referredto as the photoplethysmograph (PPG) signal. In addition, the term “PPGsignal,” as used herein, may also refer to an absorption signal (i.e.,representing the amount of light absorbed by the tissue) or any suitablemathematical manipulation thereof. The amount of light detected orabsorbed may then be used to calculate any of a number of physiologicalparameters, including oxygen saturation (the saturation of oxygen inpulsatile blood, SpO2), an amount of a blood constituent (e.g.,oxyhemoglobin), as well as a physiological rate (e.g., pulse rate orrespiration rate) and when each individual pulse or breath occurs. ForSpO2, red and infrared (IR) wavelengths may be used because it has beenobserved that highly oxygenated blood will absorb relatively less Redlight and more IR light than blood with a lower oxygen saturation. Bycomparing the intensities of two wavelengths at different points in thepulse cycle, it is possible to estimate the blood oxygen saturation ofhemoglobin in arterial blood, such as from empirical data that may beindexed by values of a ratio, a lookup table, and/or from curve fittingand/or other interpolative techniques.

Referring now to FIG. 2, an embodiment of a patient monitoring sensor100 in accordance with an embodiment is shown. As may be seen, the shapeor profile of various components may vary. The sensor 100 includes abody 102 that includes a flexible circuit. The sensor 100 includes anLED 104 (in this case a surface mount LED) and a detector 106 disposedon the body 102 of the sensor 100.

While any number of exemplary sensor designs are contemplated herein, inthe illustrated exemplary embodiment, the body 100 includes a flapportion 116 that includes an aperture 108. The flap portion 116 isconfigured to be folded ata hinge portion 114 such that the aperture 108overlaps the detector 106 to allow light to pass through. In oneembodiment, the flap portion 116 includes an adhesive 110 that is usedto secure the flap portion 116 to the body 102 after the flap portion116 is folded at the hinge portion 114. The exemplary flap portion 116increases the surface area to reduce the contact pressure from thedetector on the skin.

The sensor 100 includes a plug 120 that is configured to be connected toa patient monitoring system, such as the one shown in FIG. 1. The sensor100 also includes a cable 122 that connects the plug 120 to the body 102of the sensor 100. The cable 122 includes a plurality of wires 124 thatconnect various parts of the plug 120 to terminals 126 disposed on thebody 102. The flexible circuit is disposed in the body 102 and connectsthe terminals 126 to the LED 104 and the detector 106. In addition, oneof the terminals 126 connect a ground wire to the flexible circuit.

In exemplary embodiments, the aperture 108 is configured to provideelectrical shielding to the detector 106. In exemplary embodiments,aperture 108 also limits the amount of light that is received by thedetector 106 to prevent saturation of the detector. In exemplaryembodiments, the configuration of the aperture 108, i.e., a number,shape, and size of the openings that define the aperture 108 can vary.As illustrated, in one embodiment, the aperture 108 includes a singleround opening. In other embodiments, the aperture 108 can include one ormore openings that have various shapes and sizes. The configuration ofthe aperture 108 is selected to provide electrical shielding for thedetector 106 and/or control the amount of light that is received by thedetector 106. In exemplary embodiments, the body 102 includes a visualindicator 112 that is used to assure proper alignment of the flapportion 116 when folded at the hinge portion 114. Further, the shape ofthe material of the flap portion 116 around the aperture 108 can vary,while at the same time increasing the surface area around the detectorto reduce the contact pressure from the detector on the skin.

Referring now to FIG. 3, a patient monitoring sensor 200 in accordancewith an embodiment is shown. In exemplary embodiments, a faraday cage240 is formed around the detector 206 by folding the flap portion 116over a portion of the body 102 of the sensor 200.

As we have noted, regardless of sensor configuration particulars of theabove-described exemplary embodiments, a bandage is constructed as asingle piece such that plural layers of the bandage are configuredtogether to allow for a leaflet opening of the bandage to insert a pulseoximetry circuit therein. In exemplary embodiments, at least oneremovable internal liner or tab is included as part of the bandage tofacilitate opening of the bandage via the leaflet.

FIG. 4 illustrates an expanded perspective view generally at 300 of anexemplary layered body/bandage configuration for a pulse oximetersensor. The configuration includes: an upper bandage 350; an exemplarybottom tape/patient adhesive 352; exemplary top internal liner 354 andbottom internal liner 356, which in exemplary embodiments are discardedduring sensor assembly, allowing the bandage to open like a leaflet toinsert the flex circuit of FIGS. 2 and 3 into the bandage; a top lightblocking layer 358, for example a metallized tape; a bottom lightblocking layer 360, for example a metallized tape with holes 362configured to allow light to shine through; and a disc 364, comprisingfor example a polyethylene material, configured to reduce pressure fromthe LED on the patient. In exemplary embodiments, bottom tape 352comprises an adhesive layer with a release liner 366 on the patientfacing side of tape 352.

FIG. 5 illustrates a perspective view of exemplary assembly of the flexcircuit 200 of FIGS. 2 and 3 into the bandage 300, with internal liners354, 356 removed to allow positioning of the flex circuit 200 into thebandage, between the light blocking layers 358, 360. As is shown,detector 106 is positioned over hole 362. LED 104 is positioned overdisc 364 (which is positioned over another hole 362 (not shown in FIG.5)). Rapid assembly is facilitated by removable liners 354, 356, as wellas the upper bandage 350 and light blocking layer 358 acting as afoldable leaflet 402, the exemplary bandage construction provided as asub-assembly configured to provide high-volume, fast and repeatableproduction of sensor assemblies.

Exemplary materials for backing or other material includes plastics,such as polypropylene (PP), polyester (PES), polyethylene (PE),urethanes, silicone, or the like. Additionally, various layers of thedevice may be constructed of one or more hydrophobic materials. Bandage,backing and additional possible layers may comprise a variety ofthicknesses.

In exemplary embodiments, disc 364 is a thin disc (e.g, 0.1 millimeter(mm)polyethylene, which is semi-transparent and is operative to maintainthe light transmission from the LED through the PET) inserted in orintegral to bandage between the LED and the patient-side of the sensor,e.g., to reduce contact pressure on the skin. Other thicknesses ofmaterials are also contemplated, for example 0.08 mm-0.12 mm; 0.1mm-0.15 mm, etc. In exemplary embodiments, a PET disc 364 is convertedwith an acrylic adhesive on one side and die cut into an 8 millimeter(mm) disc (though ranges of sizes are contemplated, e.g., 5-12 mm, 6-10mm, 7-9 mm, etc.) that is adhered to the bottom tape of the sensor. Inexemplary embodiments, the bottom tape (352 in FIG. 4) has an adhesivefacing toward the disc 364, which adheres the disc in place.

In further exemplary embodiments, the LED (104 in FIG. 2) is soldered tothe flex circuit (200 in FIG. 3), which is placed on top of the adhesiveside of the disc 364 (see FIG. 5). The adhesive of the disc 364 securesthe disc in place relative to the LED 104.

Regardless, according to example embodiments described herein, theleaflet 402 configuration provides a bandage as a single piece such thatplural layers of the bandage are configured together to allow for theleaflet opening of the bandage to insert a pulse oximetry circuittherein. In exemplary embodiments, at least one removable internal lineror tab is included as part of the bandage to facilitate opening of thebandage via the leaflet.

FIG. 6 illustrates a, blown-up, perspective view of another exemplarybandage generally at 500. The exemplary bandage 500 includes an upperbandage 550 and an upper metalized tape 556 (providing shielding forsensor components, such as light sources and detectors), inserted intothe bandage 500 when the tape 556 and upper bandage 550 are foldedbackwards as a leaflet. As used herein, the term “leaflet” includes anyfolding back of the upper bandage 550 such that sensor components may beinstalled within the bandage, followed by subsequent replacement of theupper bandage over the sensor components. In exemplary embodiments, theleaflet also contains a shielding or reinforcing component, such as themetalized tape 556, that folds back with the upper bandage 550.

In further exemplary embodiments, folding back of the upper bandage 550is facilitated by at least one removable internal liner 554 (note thetwo removable liners 354 and 356 in the exemplary embodiment of FIG. 4).In exemplary embodiments, removal of the liner also exposes adhesiveused to secure sensor components in the interior of the bandage (betweenupper and lower bandage components). Tabs 355 on upper and lower liners354, 356 provide two protruding surfaces that touch each other but thatare not adhered to one another. Thus, a user can start an opening in thebandage using those tabs (in conjunction with similar contours above andbelow those removable liners) to peel the bandage open (in this case,starting on the left side where the tabs 355 are).

Further exemplary embodiments may use other or additional tabs or linersto facilitate folding back of the leaflet, for example the tab 562 inFIG. 6 provided on the lower bandage/tape 552. Such tab 562 can beconfigured to remove from or remain in a dead space within the singlepiece bandage. In one exemplary embodiment, a dead zone tab 562 can be athin, polyethylene film, or the like, without adhesive on either side tofacilitate opening of the leaflet.

Referring again the exemplary embodiment illustrated in FIG. 6, a lowermetalized tape 558 is also positioned on the lower bandage/tape 552. Inexemplary embodiments, the lower bandage/tape comprises a materialhaving a patient-side adhesive 560.

FIG. 7 illustrates an exploded, side schematic view of the exemplarybandage 500 of FIG. 6. Upper and lower bandage portions are generallyindicated by the indicated lines 564, 566, respectively. Leaflet portion568 folds up and back from the lower bandage portion 566, in thedirection of arrow 568 by virtue of liner 554, which opens up during themaneuver. An upper surface of liner 554 is adhered to bandage portion566; and a lower portion is adhered to bandage portion 564. In exemplaryembodiments, folding of the leaflet can be also facilitated by visual orfold lines 570 during manufacture or remanufacture. An optional tab 562,e.g., in a dead- or keep out-zone tab can further assist in opening thebandage by covering a portion of the adhesive to liner interface in aspecific location (e.g., at one end of the lower bandage) to make iteasier for an assembler to open the leaflet.

As we have noted, exemplary embodiments provide a single-piece bandagefor a sensor, wherein an upper part of the bandage folds away from alower bandage part to permit installation of sensor components therein.In further exemplary embodiments, the leaflet folds away along with anupper shielding or reinforcing member. In exemplary embodiments, theupper bandage portion folds away as a leaflet facilitated by at leastone removable liner or tab. In exemplary embodiments, a liner 554comprises a folded material configured to make it easy for the liner tobe grabbed and removed during assembly. After removal of, e.g., theinternal liner and placement of the electronics, the leaflet can bere-closed, completing the sensor assembly.

Thus, in exemplary embodiments, a one-piece bandage is provided withplural or all layers pre-assembled for manufacture or re-manufacture ofthe sensor. Exemplary embodiments also facilitate ease of manufacture orre-manufacture and produce reliable and repeatable alignment and contactof the layers, for example by eliminating need to manually align andlaminate layers together.

One or more specific embodiments of the present techniques will bedescribed below. In an effort to provide a concise description of theseembodiments, not all features of an actual implementation are describedin the specification. It should be appreciated that in the developmentof any such actual implementation, numerous implementation-specificdecisions must be made, which may vary from one implementation toanother.

It should be understood that various aspects disclosed herein may becombined in different combinations than the combinations specificallypresented in the description and accompanying drawings. It should alsobe understood that, depending on the example, certain acts or events ofany of the processes or methods described herein may be performed in adifferent sequence, may be added, merged, or left out altogether (e.g.,all described acts or events may not be necessary to carry out thetechniques). In addition, while certain aspects of this disclosure aredescribed as being performed by a single module or unit for purposes ofclarity, it should be understood that the techniques of this disclosuremay be performed by a combination of units or modules associated with,for example, a medical device.

What is claimed is:
 1. A patient monitoring sensor, comprising a communication interface, through which the patient monitoring sensor can communicate with a monitor; a light-emitting diode (LED) communicatively coupled to the communication interface; a detector, communicatively coupled to the communication interface, capable of detecting light; and a single piece bandage, comprising: an upper bandage portion; a lower bandage portion; and at least one releasable liner or tab provided between the upper and lower bandages to facilitate folding back of the upper bandage relative to the lower bandage and/or of the lower bandage relative to the upper bandage, further wherein the folded bandage portion is configured to fold back down over at least one of the LED and detector when the LED and/or detector is inserted between the lower bandage and the upper bandage.
 2. The patient monitoring sensor of claim 1, wherein a releasable liner exposes an adhesive configured to secure the LED and/or detector at an installation position.
 3. The patient monitoring sensor of claim 1, comprising upper and lower releasable liners for upper and lower bandage portions at an installation position.
 4. The patient monitoring sensor of claim 3, wherein the upper and lower releasable liners expose adhesive to secure the LED and/or detector at the installation position.
 5. The patient monitoring sensor of claim 1, wherein a releasable liner comprises a folded material to facilitate separation of upper and lower bandage portions.
 6. The patient monitoring sensor of claim 1, wherein at least one of the upper and lower bandage portions further include a fold line.
 7. The patient monitoring sensor of claim 1, wherein at least one of the upper and lower bandage portions further include a shielding or reinforcing member at the installation position.
 8. The patient monitoring sensor of claim 7, wherein the lower bandage portion further comprises at least one at least partially transparent thin material at an LED and/or detector position.
 9. The patient monitoring sensor of claim 7, wherein the lower bandage portion further comprises at least one at ring having an aperture therethrough at an LED and/or detector position.
 10. The patient monitoring sensor of claim 1, comprising a leaflet including a foldable upper bandage portion, the leaflet configured to open for installation of the LED and detector and to close to complete manufacture or re-manufacture of the sensor.
 11. A single piece bandage for a patient monitoring system, comprising: an upper bandage portion; a lower bandage portion; and at least one releasable liner or tab provided between the upper and lower bandages to facilitate folding back of the upper bandage relative to the lower bandage and/or of the lower bandage relative to the upper bandage, further wherein the folded bandage portion is configured to fold back down over sensor components inserted between the lower bandage and the upper bandage.
 12. The single piece bandage of claim 11, wherein a releasable liner exposes an adhesive configured to secure a pulse oximetry LED and/or detector at an installation position.
 13. The single piece bandage of claim 11, comprising upper and lower releasable liners for upper and lower bandage portions, the liners defining an openable area between the upper and lower bandage portions.
 14. The single piece bandage of claim 13, wherein the upper and lower releasable liners expose adhesive to secure a pulse oximetry LED and/or detector between the upper and lower bandage portions.
 15. The single piece bandage of claim 11, wherein a releasable liner comprises a folded material to facilitate separation of upper and lower bandage portions.
 16. The single piece bandage of claim 11, wherein at least one of the upper and lower bandage portions further include a fold line.
 17. The single piece bandage of claim 11, wherein at least one of the upper and lower bandage portions further include a shielding or reinforcing member at the installation position.
 18. The single piece bandage of claim 17, wherein the lower bandage portion further comprises at least one at least partially transparent thin material at an LED and/or detector position.
 19. The single piece bandage of claim 17, wherein the lower bandage portion further comprises at least one at ring having an aperture therethrough at an LED and/or detector position.
 20. The single piece bandage of claim 11, comprising a leaflet including a foldable upper bandage portion, the leaflet configured to open for installation of a pulse oximetry LED and detector and to close to complete manufacture or re-manufacture of the sensor. 